336425840-8-21-2026-56-AS-NBRN-DXTUD9-20260911152911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425840
Report Date: 08/21/2026
Date Signed: 08/21/2026 11:14:18 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2026 and conducted by Evaluator Eldin Serrano

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20260814080857

FACILITY NAME:	COTTAGES AT RIVERSIDE		FACILITY NUMBER:	336425840
ADMINISTRATOR:	TAWFIK, EVA		FACILITY TYPE:	740
ADDRESS:	6280 CLAY STREET		TELEPHONE:	(951) 360-1616
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	110	CENSUS:	DATE:	08/21/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Bianet Fonseca, Memory Care Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility did not provide records to resident in care.

INVESTIGATION FINDINGS:

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On 8/21/2026, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to commence the complaint investigation and deliver the findings of the above allegation. LPA explained the purpose of the visit to Memory Care Director Bianet Fonseca. The investigation consisted of interviews with staff, relevent party and record review as well as observation.

Allegation:Facility did not provide records to resident in care. Based on interviews and review of documents, LPA confirmed that facility staff provided the requested records to Resident #1 (R1) Power of Attorney (POA) representative. LPA verified this through a phone call with the attorney’s office as well as email documentation from the attorney’s representative confirming receipt of the records.No evidence was found to suggest the facility refused or failed to provide records to the resident or the resident’s authorized representative.

Based on interviews and record review, the allegation mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Memory Care Director Bianet Fonseca.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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